Jalan, R;
Sundaram, V;
Shah, P;
Wong, R;
Karvellas, C;
Fortune, B;
Mahmud, N;
(2019)
Patients With Acute on Chronic Liver Failure Grade 3 Have Greater 14‐Day Waitlist Mortality Than Status‐1a Patients.
Hepatology
, 70
(1)
pp. 334-345.
10.1002/hep.30624.
Preview |
Text
HEP-19-0097.R1.pdf - Accepted Version Download (616kB) | Preview |
Abstract
Patients listed for liver transplantation (LT) as status-1a currently receive the highest priority on the waiting list. The presence of acute on chronic liver failure with three or more organs failing (ACLF-3) portends low survival without transplantation, which may not be reflected by the model for end-stage liver disease-sodium (MELD-Na) score. We compared short-term waitlist mortality for patients listed status-1a and those with ACLF-3 at listing. Data was analyzed from the United Network for Organ Sharing (UNOS) database, years 2002-2014 for 3,377 patients listed status- 1a and 5,099 patients with ACLF-3. Candidates with ACLF were identified based on the EASLCLIF criteria. MELD-Na score was treated as a categorical variable of scores <36, between 36- 40 and >40. We used competing risks regression to assess waitlist mortality risk. Evaluation of outcomes through 21 days after listing demonstrated a rising trend in mortality among ACLF-3 patients at 7 days (18.0%), 14 days (27.7%) and 21 days (32.7%) (p<0.001), compared to a stable trend in mortality among individuals listed as status-1a at 7 days (17.9%), 14 days (19.3%) and 21 days (19.8%), (p=0.709). Multivariable modeling with adjustment for MELD-Na category revealed that patients with ACLF-3 had significantly greater mortality (SHR=1.45, 95% CI 1.31-1.61) within 14 days of listing compared to status-1a candidates. Analysis of the interaction between MELD-Na category and ACLF-3 showed patients with ACLF-3 had greater risk of 14-day mortality than status-1a listed patients, across all three MELD-Na categories. Conclusion: Patients with ACLF-3 at the time of listing have greater 14-day mortality than those listed as status-1a, independent of MELD-Na score. These findings illustrate the importance of early transplant evaluation and consideration of transplant priority for patients with ACLF-3.
| Type: | Article |
|---|---|
| Title: | Patients With Acute on Chronic Liver Failure Grade 3 Have Greater 14‐Day Waitlist Mortality Than Status‐1a Patients |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/hep.30624 |
| Publisher version: | https://doi.org/10.1002/hep.30624 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | cirrhosis, liver transplantation, portal hypertension, organ allocation, MELD score |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10070161 |
Archive Staff Only
 |
View Item |
